Sample Written Request Form
Per AB 104, any student who received a D or F (grades 3-11) or 1 or 2 (grades K-2) in half or more of their academic courses during the 2020-21 school year may request a consultation for grade-level retention consideration.
If you would like to request a consultation, please complete this form and submit to your student’s 2020-21 School Principal.
Retention Request Form Spanish
Retention Request Form English
Retention Request Form Chinese
AB 104
- “Any student who received a D or F (grades 3-11) or 1 or 2 (grades K-2) in half or more of their academic courses during the 20202-21 school year may be considered for grade-level retention. If you would like to schedule a Consultation, please contact your student’s 2020-21 Principal to submit a written request.”
- “在 2020-21 學年期間，在一半或更多的學術課程中獲得 D 或 F（3-11 年級）； 1 或 2（K-2 年級）的學生都可以考慮申請留在同一個年級不升級. 如果您想安排諮詢，請聯繫您學生在 2020-21 學年度的 校長以提交書面請求.”
- “Cualquier estudiante que recibió una calificación D o F (del 3o al 11o grado) o un 1 o 2 (del Kínder al 2o grado) en la mitad o más de sus materias académicas durante el ciclo escolar 2020-21, podría ser considerado para repetir grado. Si desea programar una consulta, comuníquese con el Director de su estudiante del ciclo escolar 2020-21 para presentar una solicitud por escrito.”
- Requests must be submitted/documented to the school in written form. A request may be in the form of email, letter, verbal request documented in Aeries, or by using the attached Written Request Form.
- Schools to hold a Consultation with families who requested retention within 30 calendar days of receiving the written request.
- If an SFT/Consultation was already held in the Spring, check that all required components were addressed.
- Parent provided opportunity to meet with admin, teacher, and student.
- Discussion of all available learning recovery options, including:
- Specific interventions and supports
- Access to prior semester courses in which the pupil received a D or F letter grade in the 2020–21 academic year, some other form of credit recovery, or other support
- Consideration of the pupil’s academic data and any other information relevant to whether retention is in the pupil’s best interests, academically and socially.
- Discussion about research on the effects of pupil retention and the types of interventions and supports that have been shown to be beneficial to pupils.
- A local educational agency shall ensure that a retention decision is consistent with an eligible pupil’s individualized education program.
- If any of the above was not covered, schools to schedule follow-up Consultation; document discussion and decision using Decision Form (attached)
- A decision must be provided to the parent within 10 calendar days of the Consultation.
- If an SFT/Consultation has not yet been held:
- Hold the meeting within 30 days of when the written request was made.
- Parent must be provided opportunity to meet with admin, teacher, student. A req may be submitted for ratification if Consultation occurs in the summer.
- Ensure the above required Consultation components are met. The Decision Form may be used to ensure all points are covered.
- A decision must be provided to the parent within 10 calendar days of the Consultation.
- Hold the meeting within 30 days of when the written request was made.
- A pupil retained shall also be offered supplemental interventions and supports
- A pupil who is not retained shall be offered both of the following:
- Specific interventions and support.
- Access to prior semester courses in which the pupil received a D or F letter grade in the 2020–21 academic year, some other form of credit recovery, or other supports
